Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 402842 | NY |
NPI | 1003467101 |
---|---|
Provider Name | Kristen Colandrea |
First Address | Staten Island, NY 10305-3436 |
Second Address | Staten Island, NY 10305-3436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2019 |
Last Update Date | 20/09/2019 |